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Someone needs to lend syndicated columnist Paul Krugman a dictionary so he can look up the word “privatization” (“Medicare privatization continues apace,” April 23).
He’s correct to criticize Bush’s massive 2003 Medicare drug entitlement. But that’s not privatization, which means getting the government entirely out of a given market, both funding and delivery.
Ironically, Krugman and Bush (as well as the Republicans in Congress who passed this monstrosity) seem to agree that the only alternatives are medical socialism (coercion for the alleged benefit of the masses, favored by liberals) or medical fascism (coercion for the benefit of the insurance companies and other well-connected businesses, favored by conservatives).
There is a third option, the only one that will provide the results people are seeking: a truly free market in medical care and medical insurance.

Will Ropke, Franktown

READER COMMENTS

Will, you libertarians got about one percent of the vote in 2006. There's a reason for that "popularity". Keep trying though. Maybe you will be able to increase that to one a half percent in 2008.

Was that your grandfather who was so disgusted with Teddy Roosevelt for "socializing" America, that is, taking it out of the hands of the robber barons?

From a political standpoint, you are the equivalent of those who still think the sun goes around the earth.

What would help in the cost of medical care would be a two teir system. One that would give us the opportunity to opt out of the current system that allows our tort system to jack the price up to cover the legal cost. The second and more costly system would let everything be status quo for the people that want the "RIGHT" to sue a care giver for anything they or their attorney see as a way to "CASH IN".

Mr. Evans, yes, our tort system allows citizens to sue healthcare providers. Are you suggesting we do away with that?

Also, and some people get irritated when I mention this, but research shows that malpractice costs account for 2% of our country's overall healthcare spending. And out of that 2%, probably a fraction out of one percent accounts for paying out claims, as research also shows that the majority of claims without merit do not receive compensation.

With this in mind, is taking away Americans' access to the courts really worth "reforming" our tort system?

With this in mind, and in the terms of your theory, would taking away your access and my access to the courts eliminate outrageous healthcare costs, so that most people could afford healthcare?

My thoughts, a work in progress, on tort reform:

As of principle rather than practicality, we should look at the idea of having punitive damages go to the state rather than to the plaintiff. Theoretically, but I suspect only theoretically, compensatory damages are supposed to take care of the plaintiff's loses. You might say that compensatory damages are imposed because of the damage to the plaintiff, whereas punitive damages are imposed because of the damage to the state, that is, to the population as a whole. Punitive damages, again theoretically, are not designed to compensate the plaintiff but rather to discourage others from damaging the general population by replicating the defendant's wrongdoing. I think it is arguable that it is the general population rather than the plaintiff who should benefit from such fines. Perhaps there could be a punitive damages fund to be used, for one thing, to publicize the award since a punitive damages award won't act to deter others if they don't know about it. The fund perhaps could also be used to educate the appropriate parties about how to avoid the conduct giving rise to the punitive damages award.

There may be good practical reasons why this idea is unsound, but I'd like to see it debated, I don't mean here but at a somewhat higher level.

Truth, could you clarify if you are also putting forth that such a reform would be a significant part of a solution to combating outrageous healthcare costs overall? Or are your comments a side-observation about punitive damages?

Because essentially what I am asking Mr. Evans is why he believes our present tort system is to blame for high healthcare costs.

hey da truth you really do love having government take care of you. the plaintiff awards go to the state? you really should look at the country you are living in and consider going to france as they will take care of you so you will never have a need to provide for yourself.
why dont you run for an elected office? how wonderful you would be telling everyone how to live and what you would allow them to have all according to 'truth'

MTS, do you have a source to offer on how the costs break down?

If I remember correctly the biggest costs were the "heroic effort" stuff and for prolonging life in the elderly.
I would like to see something with a bit finer granularity if you have it.

Hi, Bango...are you asking me for a medical malpractice costs breakdown, or a healthcare expenditures in this country breakdown?

If the latter, I just found this study from Kaiser, but they don't even mention malpractice costs, so I am not sure if this is helpful or not: http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

You could probably find many other studies out there that breakdown all healthcare expenditures, and compare to see if there is a general trend of consistency in the stats.

Here is the source for the 2% malpractice costs I have quoted: http://www.cbo.gov/showdoc.cfm?index=4968&sequence=0 Actually, this is a very informative report that delves quite in-depthly on the subject of malpractice and its effect on healthcare expenditures. Really, just about everyone could take supporting points on their position from it, whether they're pro-tort "reform" or not.

And here is another source I quoted in the past that gives .46% as the total amount spent defending malpractice claims (not to replace the category of overall malpractice costs, but placed within that category): http://content.healthaffairs.org/cgi/content/abstract/24/4/903

And just for kicks and giggles, anyone who is interested in reading a discussion John II and I had about this stuff can visit: http://blogs.rockymountainnews.com/denver/letters/2007/04/health_care_in_colorado.html#comments

The discussion took place in our "salad" days before we began to intensely annoy each other, lol.

I just want to say a couple things about the sources I quote: I realize most of them are at least a few years old. However, I am wary about using sources from obviously biased blogs, think tanks, etc. First off, I wouldn't expect anyone to consider them irrefutably creditable, and second, most of them are just using the more dated, but neutral sources I quote anyway, and putting their own spin on them.

If anyone can come up with 2006 & 2007 numbers for some of this stuff from neutral sources, I'd be obliged!

Test post - the response I made to Bango included a lot of URL links, and I received a message window that my comments were waiting for approval. Anyone else ever had that happen?

mytwosense

I've given up completely on hyperlinks. They just drop out every time I try to put one in. How to get them past whoever is cutting them out, I don't know.

I have read - back a while - that there is some monitoring on the site. It mostly seems to focus on hyperlinks, which they want to make certain do not go to XXXXX rated sites, etc. And, from what the writer said back then, the job may not always get done, or even begun; so the posting with hyperlink just . . . . . . . . . . . . .

I would guess the larger number in the posting, the larger the possibility no one is going to follow through on clearing it.

No more than 2 links can be posted per message.

Ah, I'll chill out on the hyperlinks in the future, then...

Sorry Truth,

I usually agree with you, but today you are wrong.

No such thing as punitive damages in medical liability.

There are economic damages (medical bills time lost from work, future earnings lost, etc.) and noneconomic damages (pain and suffering.)

Say a plaintiff wins all their economic damages which are objectively quantifiable. The lawyer has expenses involved in bringing the case, and then they want to get paid. The 'free market" the cons love to tout should reward their hard work. If that comes out of the economic damages, then the plaintiff's legitimate costs are not covered.

Problem is that noneconomic damages (out of which attorneys fees must come if the plainitff is to be made whole) are completely subjective, nonquantifiable, and variable from one jurisdiction to another.

Just my $.02

So the third option is something along the lines of "each man for himself, and the devil take the hindmost"?

mytwosense, I made my comments about punitive damages only as a side observation because it is something I have been thinking about and have discussed with people. I really haven't looked into the impact on health care costs. This just looked like a convenient place for me to air my thoughts. I do think that the draconian awards of punitive damages are bad for the judicial system and unfair to the average plaintiff because they create an undue prejudice against malpractice suits. And I suspect that they sometimes tempt lawyers to put the possibility of such an award ahead of the needs of the client since going for such an award can also lead to a lost lawsuit when a handsome settlement would have been possible. And the awards might also tempt people to go for such an award even though they really weren't injured all that badly and would otherwise have agreed to a reasonable settlement. Lawsuits are very trying business for plaintiffs and can inflict a great deal of stress on them, so that from the standpoint of the client a settlement is often the most desirable outcome, provided, of course, that it is a reasonable one and not one the lawyer encourages simply because he has bigger fish to fry. I guess that the essence of my position is that many punitive awards are windfalls that distort the picture to the disadvantage of the average Joe.

To Doc, I'm not sure I understand you. A jury can award punitive damages in a medical malpractice suit if the conduct of the defendant is something like wanton or reckless, something that the court believes should be punished.

But I agree that what are theoretically punitive damages may be necessary to properly compensate the plaintiff because of the fact that the lawyer takes a big bite out of the award and because the jury may be too conservativei n assessing non-economic damages.

A possibility would be to require that the lawyer's fees come out of punitive damages.

I admit that my thoughts are just preliminary thoughts not bottomed on sufficient knowledge or research. I'd just like to see a reasoned debate on the topic since I do dislike the idea of one plaintiff getting multiples of what another with similar injuries gets simply because a jury goes a little or a lot wild on punitive damages. I do think that the very high punitive damage awards distort the picture to the disadvantage of the average plaintiff. But I may be all wet.

My understanding is that what is called the "English Rule" is in effect in most countries, requiring the losing party to pay the attorney fees of the winning party. http://en.wikipedia.org/wiki/Attorney's_fees#Loser_pays

Perhaps we should adopt such a rule in the United States. Or maybe some variety of it, such as requiring a jury finding that the losing party had little or no justification for bringing or defending the suit. And perhaps the rule should extend as well to expert witness fees.

Or perhaps have punitive damages go into a fund which would then be used to pay attorney and maybe expert witness fees of the plaintiff who wins.

I don't have any statistics but I feel sure that punitive damages are awarded in only a very small fraction of cases but the way they are used in the debate you would think that punitive damages are the rule rather than the exception. It is for that reason that I think punitive damages that go to the plaintiff may do a disservice to the big majority of plaintiffs by resulting in changes in the law which are inimical to plaintiffs in general.

Question for Truth (first comment in this thread)

Who were the robber barons and what control did they have over anyone? Did they force people to buy their products or work in their factories? If so, please let me know the facts behind that.

Because the truth is that no corporation in a true free-market has any control over anyone. No one can force me to shop at Wal-Mart, or eat at McDonalds, or use Microsoft products or Nike clothes. Nor can anyone force me to work anywhere. The only force comes from the use of the State, which corporations (those mentioned above) are very good at using. These large companies continuously lobby for regulations and other forms of protectionism that is drafted into laws to do exactly that -- protect them from competition at the expense of the consumers.

I'd love to hear your thoughts.

Nice letter, Will. To connect with other advocates of individual freedom and choice in medicine in Colorado, look at FIRM: Freedom and Individual Rights in Medicine. Their website is www.WeStandFirm.org. Also see my proposal to the 208 Commission on Health Care Reform at www.WhoOwnsYou.org.

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